Provider Demographics
NPI:1164014064
Name:MED-ADVO-C, LLC
Entity Type:Organization
Organization Name:MED-ADVO-C, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMURRAY-WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-972-9715
Mailing Address - Street 1:2314 S ROUTE 59 # 217
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-7756
Mailing Address - Country:US
Mailing Address - Phone:708-972-9715
Mailing Address - Fax:
Practice Address - Street 1:1505 YORKSHIRE CT
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431
Practice Address - Country:US
Practice Address - Phone:708-972-9715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service